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Ryan GW, Perry SS, Scherer A, Charlton ME, Ashida S, Gilbert PA, Askelson N. Factors contributing to missed opportunities for human papillomavirus vaccination among adolescents, ages 11 to 13, in Iowa. Vaccine X 2022; 11:100192. [PMID: 35864862 PMCID: PMC9294328 DOI: 10.1016/j.jvacx.2022.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Rates of human papillomavirus (HPV) vaccination remain low and missed opportunities for HPV vaccination are widespread. Researchers have identified factors related to HPV vaccination, but less is known about missed opportunities. Methods We used medical claims data from a large Midwestern insurance provider to explore relationships between adolescent and provider characteristics and missed opportunities for HPV vaccination. We stratified models by initiation status with adolescents who had received one or more HPV vaccinations in one group (n = 6,123) and adolescents with no record of an HPV vaccination in the other (n = 8,107). Results There were significant differences in comparisons of all variables between initiators and non-initiators. Notably, non-initiators had lower rates of vaccination for HPV and other adolescent vaccinations, and fewer well-child visits. For all adolescents, birth year, having other recommended vaccines, and number of well-child visits were significantly associated with missed opportunities. Additionally, among initiators, pediatrician as a primary care provider and being in a rural area were significantly associated. Discussion Overall, adolescents with greater healthcare utilization had more missed opportunities, indicating that, despite increased numbers of visits, providers are not taking advantage of these opportunities to vaccinate. Future research should prioritize developing a deeper understanding of why these missed opportunities are occurring and implementing new and existing strategies to prevent them. Reducing missed opportunities will help to prevent future HPV-related cancers and the significant morbidity and mortality that they can cause.
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Affiliation(s)
- Grace W. Ryan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
- Corresponding author at: 368 Plantation St., Worcester, MA 01605, United States.
| | - Sarah S. Perry
- Department of Biostatistics, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
| | - Aaron Scherer
- Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City IA, 52242, United States
| | - Mary E. Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
| | - Sato Ashida
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
| | - Paul A. Gilbert
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City IA, 52242, United States
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Conderino S, Bendik S, Richards TB, Pulgarin C, Chan PY, Townsend J, Lim S, Roberts TR, Thorpe LE. The use of electronic health records to inform cancer surveillance efforts: a scoping review and test of indicators for public health surveillance of cancer prevention and control. BMC Med Inform Decis Mak 2022; 22:91. [PMID: 35387655 PMCID: PMC8985310 DOI: 10.1186/s12911-022-01831-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION State cancer prevention and control programs rely on public health surveillance data to set objectives to improve cancer prevention and control, plan interventions, and evaluate state-level progress towards achieving those objectives. The goal of this project was to evaluate the validity of using electronic health records (EHRs) based on common data model variables to generate indicators for surveillance of cancer prevention and control for these public health programs. METHODS Following the methodological guidance from the PRISMA Extension for Scoping Reviews, we conducted a literature scoping review to assess how EHRs are used to inform cancer surveillance. We then developed 26 indicators along the continuum of the cascade of care, including cancer risk factors, immunizations to prevent cancer, cancer screenings, quality of initial care after abnormal screening results, and cancer burden. Indicators were calculated within a sample of patients from the New York City (NYC) INSIGHT Clinical Research Network using common data model EHR data and were weighted to the NYC population using post-stratification. We used prevalence ratios to compare these estimates to estimates from the raw EHR of NYU Langone Health to assess quality of information within INSIGHT, and we compared estimates to results from existing surveillance sources to assess validity. RESULTS Of the 401 identified articles, 15% had a study purpose related to surveillance. Our indicator comparisons found that INSIGHT EHR-based measures for risk factor indicators were similar to estimates from external sources. In contrast, cancer screening and vaccination indicators were substantially underestimated as compared to estimates from external sources. Cancer screenings and vaccinations were often recorded in sections of the EHR that were not captured by the common data model. INSIGHT estimates for many quality-of-care indicators were higher than those calculated using a raw EHR. CONCLUSION Common data model EHR data can provide rich information for certain indicators related to the cascade of care but may have substantial biases for others that limit their use in informing surveillance efforts for cancer prevention and control programs.
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Affiliation(s)
- Sarah Conderino
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA.
| | - Stefanie Bendik
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Thomas B Richards
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Claudia Pulgarin
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Pui Ying Chan
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY, 11101, USA
| | - Julie Townsend
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Sungwoo Lim
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY, 11101, USA
| | - Timothy R Roberts
- Health Sciences Library, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
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Ramírez M, de la Fuente J, Andía D, Hernández JJ, Fiol G, Torné A. "HPV vaccination coverage in women between 15-55 years in Spain. Temporal trend during the period 2007-2020". Int J Gynaecol Obstet 2021; 158:705-713. [PMID: 34905216 DOI: 10.1002/ijgo.14067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/26/2021] [Accepted: 12/12/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Mar Ramírez
- Gynecology Oncology Unit. Institute of Women's Health José Botella Llusiá. Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University, Madrid, Spain
| | - Jesús de la Fuente
- Gynecology and Obstetrics Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Daniel Andía
- Gynecology and Obstetrics Department, Basurto University Hospital, Bilbao, Spain
| | - Juan José Hernández
- Gynecology and Obstetrics Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Gabriel Fiol
- Gynecology Oncology Unit, Torrecárdenas University Hospital, Almeria, Spain
| | - Aureli Torné
- Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Spain
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Milondzo T, Meyer JC, Dochez C, Burnett RJ. Misinformation Drives Low Human Papillomavirus Vaccination Coverage in South African Girls Attending Private Schools. Front Public Health 2021; 9:598625. [PMID: 33681125 PMCID: PMC7933005 DOI: 10.3389/fpubh.2021.598625] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cervical cancer, caused by persistent human papillomavirus (HPV) infection, is the leading cause of female cancer deaths in South Africa. In 2014, the South African National Department of Health introduced a free public sector school-based HPV vaccination programme, targeting grade 4 girls aged ≥9 years. However, private sector school girls receive HPV vaccination through their healthcare providers at cost. This study investigated HPV vaccination knowledge, attitudes and practices of caregivers of girls aged ≥9 years in grades 4-7 attending South African private schools. Methods: A link to an online survey was circulated to caregivers via an email sent to school principals of all private schools in four provinces enrolling girls in grades 4-7. Following a poor post-reminder response, a paid Facebook survey-linked advert targeting South African Facebook users aged ≥25 years nationally was run for 4 days, and placed on the South African Vaccination and Immunisation Centre's Facebook page for 20 days. Results: Of 615 respondents, 413 provided HPV vaccination data and 455 completed the knowledge and attitudes tests. Most (76.5%) caregivers had good knowledge and 45.3% had positive attitudes. Of their daughters, 19.4% had received ≥1 dose of HPV vaccine. Of caregivers of unvaccinated girls, 44.3% and 41.1%, respectively were willing to vaccinate their daughters if vaccination was offered free and at their school. Caregivers of unvaccinated girls were more likely [odds ratio (OR): 3.8] to have been influenced by "other" influences (mainly online articles and anecdotal vaccine injury reports). Of caregivers influenced by their healthcare providers, caregivers of unvaccinated girls were more likely (OR: 0.2) to be influenced by alternative medical practitioners. Caregivers of vaccinated girls were more likely to have good knowledge (OR: 3.6) and positive attitudes (OR: 5.2). Having good knowledge strongly predicted (OR: 2.8) positive attitudes. Having negative attitudes strongly predicted (OR: 0.2) girls being unvaccinated. Conclusion: Providing free school-based HPV vaccination in the private sector may not increase HPV vaccination coverage to an optimal level. Since misinformation was the main driver of negative attitudes resulting in <20% of girls being vaccinated, an advocacy campaign targeting all stakeholders is urgently needed.
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Affiliation(s)
- Tracy Milondzo
- Department of Public Health, University of Limpopo, Polokwane, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Carine Dochez
- Network for Education and Support in Immunisation, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Rosemary J Burnett
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Adjei Boakye E, Lew D, Muthukrishnan M, Tobo BB, Rohde RL, Varvares MA, Osazuwa-Peters N. Correlates of human papillomavirus (HPV) vaccination initiation and completion among 18-26 year olds in the United States. Hum Vaccin Immunother 2018; 14:2016-2024. [PMID: 29708826 DOI: 10.1080/21645515.2018.1467203] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To examine correlates of HPV vaccination uptake in a nationally representative sample of 18-26-year-old adults. METHODS Young adults aged 18-26 years were identified from the 2014 and 2015 National Health Interview Survey (n = 7588). Survey-weighted multivariable logistic regression models estimated sociodemographic factors associated with HPV vaccine initiation (≥1 dose) and completion (≥3 doses). RESULTS Approximately 27% of study participants had initiated the HPV vaccine and 16% had completed the HPV vaccine. Participants were less likely to initiate the vaccine if they were men [(adjusted odds ratio) 0.19; (95% confidence interval) 0.16-0.23], had a high school diploma (0.40; 0.31-0.52) or less (0.46; 0.32-0.64) vs. college graduates, and were born outside the United States (0.52; 0.40-0.69). But, participants were more likely to initiate the HPV vaccine if they visited the doctor's office 1-5 times (2.09; 1.56-2.81), or ≥ 6 times (1.86; 1.48-2.34) within the last 12 months vs. no visits. Odds of completing HPV vaccine uptake followed the same pattern as initiation. And after stratifying the study population by gender and foreign-born status, these variables remained statistically significant. CONCLUSIONS In our nationally representative study, only one out of six 18-26 year olds completed the required vaccine doses. Men, individuals with high school or less education, and those born outside the United States were less likely to initiate and complete the HPV vaccination. Our findings suggest that it may be useful to develop targeted interventions to promote HPV vaccination among those in the catch-up age range.
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Affiliation(s)
- Eric Adjei Boakye
- a Saint Louis University Center for Health Outcomes Research (SLUCOR), Saint Louis University , Saint Louis , MO , USA
| | - Daphne Lew
- b Department of Biostatistics , College for Public Health and Social Justice, Saint Louis University , Saint Louis , MO , USA
| | - Meera Muthukrishnan
- c Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , Saint Louis , MO , USA
| | - Betelihem B Tobo
- c Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , Saint Louis , MO , USA
| | - Rebecca L Rohde
- d Saint Louis University School of Medicine , Saint Louis , MO , USA
| | - Mark A Varvares
- e Department of Otolaryngology , The Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Nosayaba Osazuwa-Peters
- c Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , Saint Louis , MO , USA.,f Department of Otolaryngology-Head and Neck Surgery , Saint Louis University , Saint Louis , MO , USA.,g Saint Louis University Cancer Center , Saint Louis , MO , USA
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Wilson AR, Hashibe M, Bodson J, Gren LH, Taylor BA, Greenwood J, Jackson BR, She R, Egger MJ, Kepka D. Factors related to HPV vaccine uptake and 3-dose completion among women in a low vaccination region of the USA: an observational study. BMC Womens Health 2016; 16:41. [PMID: 27449775 PMCID: PMC4957275 DOI: 10.1186/s12905-016-0323-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the demographic and attitudinal factors associated with HPV vaccine initiation and completion among 18-26 year old women in Utah. METHOD Between January 2013 and December 2013, we surveyed 325 women from the University of Utah Community Clinics about their HPV vaccine related beliefs and behaviors. Odds ratios (ORs) were estimated from logistic regression models to identify variables related to HPV vaccine initiation and series completion. RESULTS Of the 325 participants, 204 (62.8 %) had initiated the vaccine and 159 (48.9 %) had completed the 3-dose series. The variables associated with HPV vaccine initiation were lower age (OR = 1.18 per year); being unmarried (OR = 3.62); not practicing organized religion (OR = 2.40); knowing how HPV spreads (OR = 6.29); knowing the connection between HPV and cervical cancer (OR = 3.90); a belief in the importance of preventive vaccination (OR = 2.45 per scale unit); strength of doctor recommendation (OR = 1.86 per scale unit); and whether a doctor's recommendation was influential (OR = 1.70 per scale unit). These variables were also significantly associated with HPV vaccine completion. CONCLUSION The implications of these findings may help inform policies and interventions focused on increasing HPV vaccination rates among young women. For example, without this information, programs might focus on HPV awareness; however, the results of this study illustrate that awareness is already high (near saturation) in target populations and other factors, such as strong and consistent physician recommendations, are more pivotal in increasing likelihood of vaccination. Additionally, our findings indicate the need for discussions of risk assessment be tailored to the young adult population.
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Affiliation(s)
- Andrew R. Wilson
- />University of Utah, College of Nursing, 10 South 2000 East, Room 2200, Salt Lake City, Utah 84112 USA
| | - Mia Hashibe
- />Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, Utah 84112 USA
- />University of Utah, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste, A Salt Lake City, Utah 84108 USA
| | - Julia Bodson
- />Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, Utah 84112 USA
| | - Lisa H. Gren
- />University of Utah, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste, A Salt Lake City, Utah 84108 USA
| | - Brooke A. Taylor
- />University of Utah, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste, A Salt Lake City, Utah 84108 USA
| | - Jessica Greenwood
- />University of Utah, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste, A Salt Lake City, Utah 84108 USA
| | - Brian R. Jackson
- />ARUP Laboratories, 500 Chipeta Way, Salt Lake City, Utah 84108 USA
- />Department of Pathology, University of Utah, 15 North Medical Drive East, Salt Lake City, Utah 84112 USA
| | - Rosemary She
- />University of Southern California, Keck School of Medicine, 1975 Zonal Ave, Los Angeles, California 90033 USA
| | - Marlene J. Egger
- />University of Utah, Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste, A Salt Lake City, Utah 84108 USA
| | - Deanna Kepka
- />University of Utah, College of Nursing, 10 South 2000 East, Room 2200, Salt Lake City, Utah 84112 USA
- />Huntsman Cancer Institute, Cancer Control and Population Sciences, 2000 Circle of Hope, Salt Lake City, Utah 84112 USA
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Thompson EL, Vamos CA, Sappenfield WM, Straub DM, Daley EM. Relationship status impacts primary reasons for interest in the HPV vaccine among young adult women. Vaccine 2016; 34:3119-3124. [DOI: 10.1016/j.vaccine.2016.04.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
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Thompson EL, Vamos CA, Vázquez-Otero C, Logan R, Griner S, Daley EM. Trends and predictors of HPV vaccination among U.S. College women and men. Prev Med 2016; 86:92-8. [PMID: 26868093 DOI: 10.1016/j.ypmed.2016.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND HPV vaccination was recommended by the Advisory Committee on Immunization Practices for young adult females in 2006 and males in 2011 to prevent HPV-related cancers and genital warts. As this prevention mechanism continues to disseminate, it is necessary to monitor the uptake of this vaccine. College students represent an important population for HPV vaccination efforts and surveillance due to increased risk for HPV infection and representing a priority population for catch-up HPV vaccination. The purpose of this study was to assess the trends in HPV vaccination among U.S. college females and males from 2009 to 2013, and to examine whether predictors for HPV vaccination differ between males and females. METHODS The National College Health Assessment-II (Fall 2009-2013) was used to assess trends in HPV vaccination using hierarchical logistic regression across genders and demographics. Data from 2013 were used to assess demographic variables associated with HPV vaccination for males and females, respectively. The analysis was conducted in 2015. RESULTS Females had nearly double the rates of HPV vaccination compared to males over time. All demographic sub-groups had significant increases in vaccine rates over time, with select male sub-groups having more accelerated increases (e.g., gay). Young age (18-21 vs. 22-26years) was a significant predictor for HPV vaccination among males and females, while race/ethnicity was a predictor of vaccination among females only. CONCLUSIONS These findings identified specific demographic sub-groups that need continued support for HPV vaccination. Campus health centers may be rational settings to facilitate clinical opportunities for HPV vaccination among unvaccinated college students.
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Affiliation(s)
- Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Coralia Vázquez-Otero
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Rachel Logan
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Stacey Griner
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
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Lu PJ, O'Halloran A, Williams WW. Impact of health insurance status on vaccination coverage among adult populations. Am J Prev Med 2015; 48:647-61. [PMID: 25890684 PMCID: PMC5826635 DOI: 10.1016/j.amepre.2014.12.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/25/2014] [Accepted: 12/09/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Underinsurance is a barrier to vaccination among children. Information on vaccination among adults aged ≥18 years by insurance status is limited. This study assesses vaccination coverage among adults aged ≥18 years in the U.S. in 2012 by health insurance status and access to care characteristics. METHODS The 2012 National Health Interview Survey data were analyzed in 2014 to estimate vaccination coverage among adults aged ≥18 years by health insurance status for seven routinely recommended vaccines. RESULTS Influenza vaccination coverage among adults aged ≥18 years without or with health insurance was 14.4% versus 44.3%, respectively; pneumococcal vaccination coverage among adults aged 18-64 years with high-risk conditions was 9.8% versus 23.0%; tetanus and diphtheria toxoid (Td) coverage (age ≥18 years) was 53.2% versus 64.5%; tetanus, diphtheria, and acellular pertussis (Tdap) coverage (age ≥18 years) was 8.4% versus 15.7%; hepatitis A (HepA) coverage (age 18-49 years) was 16.6% versus 19.8%; hepatitis B (HepB) coverage (age 18-49 years) was 27.5% versus 38.0%; shingles coverage (age ≥60 years) was 6.1% versus 20.8%; and human papillomavirus (HPV) coverage (women aged 18-26 years) was 20.9% versus 39.8%. In addition, vaccination coverage differed by insurance type, whether respondents had a regular physician, and number of physician contacts. CONCLUSIONS Overall, vaccination coverage among adults aged ≥18 years is lower among uninsured populations. Implementation of effective strategies is needed to help improve vaccination coverage among adults aged ≥18 years, especially those without health insurance.
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Affiliation(s)
- Peng-jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
| | - Alissa O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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